Share your information with AICHA BAH

AICHA BAH

MIAH Travel

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  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Departure Airport" name="departure-airport" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Cruise Line" name="cruise-line" className="form-control">&#13;
			<option label="Royal Carribean" value="royal-carribean">Royal Carribean</option>&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="Disney Cruise Lines" value="disney-cruise-lines">Disney Cruise Lines</option>&#13;
			<option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option>&#13;
			<option label="Celebrity Cruises" value="celebrity-cruises">Celebrity Cruises</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Which cabin category are you interested in?" name="which-cabin-category-are-you-interested-inselect">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Ocean View" value="ocean-view">Ocean View</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many travelers? (If more than 8 people, select the Group Trips Inquiry form)" name="how-many-travelers-if-more-than-8-people-select-the-group-trips-inquiry-form" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many cabins? (More than 4 rooms, select the Group Trips Inquiry form)" name="how-many-cabins-more-than-4-rooms-select-the-group-trips-inquiry-form" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many people in each room? (Please specify whether adult or child and the age of each traveler)*" name="how-many-people-in-each-room-please-specify-whether-adult-or-child-and-the-age-of-each-traveler" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" name="where-would-you-like-to-go" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What date do you want to set sail? (Provide exact travel dates or date range)" name="what-date-do-you-want-to-set-sail-provide-exact-travel-dates-or-date-range" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many kids and ages?" name="how-many-kids-and-ages" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Repeat Cruiser" name="repeat-cruise">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="Any additional information I need to know? (Birthday, Anniversary, Family Reunion, Graduation)" name="any-additional-information-i-need-to-know-birthday-anniversary-family-reunion-graduation" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Complete this form ONLY for SERIOUS travel inquiries. Please allow 2-3 business days to receive your cruise vacation quote via email. The cruise quote ONLY INCLUDES fare, taxes and port fees. Travel Insurance and gratuities may be added to the booking at time of deposit. If gratuities are NOT pre-paid, they MUST be paid directly to the cruise line while on board."/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>